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What does an Insurance Fraud Attorney do?

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  • Written By: Ken Black
  • Edited By: Andrew Jones
  • Last Modified Date: 16 June 2018
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    Conjecture Corporation
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An insurance fraud attorney is a person who is specifically tasked with litigating cases relating to insurance fraud. Such an attorney could be working for the insurance carrier or, in the case of a consumer fraud lawyer, may work on behalf of an individual, or the government. If working for the government, the main objective will be prosecuting civil cases, though they could also participate in some criminal matters. Those working for insurance or private individuals will mainly be interested in civil litigation.

An insurance fraud attorney working for an insurance company will work closely in conjunction with the insurance investigator, or claims adjuster. If there is a reason to believe a claim is fraudulent, the attorney may begin legal proceedings. Most of the time, attorneys will work on disability and auto insurance cases. By the very nature of these two areas, they are more susceptible to fraud. In such cases, the goal will be to recoup any money that was paid out fraudulently.

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If the case is compelling enough, and the evidence is strong enough, an insurance fraud attorney may work closely with a local prosecutor as well. In such a situation, the defendant may not only be brought into court on civil litigation, but also face criminal charges. Often, the litigation used in the course of the civil case will be valuable to the prosecutor when looking at criminal charges. There is no rule against the two attorneys cooperating with each other on separate cases.

An insurance fraud attorney can be very busy, simply because he or she will be responsible for multiple open cases at the same time. Some attorneys may focus on fraud cases involving disability. Others may work specifically on automobile insurance cases. Many will work on a variety of cases, especially at larger firms that handle more than one type of insurance product. Though they often have a staff and aides that help juggle some of these issues, the attorneys themselves will still need to keep track of many different schedules, make sure all required filings are handled on time, schedule witnesses for depositions and trials, and other duties.

In the case of an insurance fraud attorney working for the government, it is the insurance carriers themselves that often become a target, because of unscrupulous practices toward consumers. Such cases may be handled either by an insurance fraud attorney, or a consumer fraud attorney, depending on the situation, and the workload of the attorneys. Most of the time, these situations may be handled under a class-action statute, which allows plaintiff attorneys to, in effect, represent all of those who may have been wronged.

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anon179338
Post 4

is it fraud for a parent to health insure a college age child and when the carrier pays a legitimate claim directly to the parent instead of the health care provider for the parent to keep the funds?

anon128365
Post 3

my insurance agent told me he was selling me term insurance but ended up with an expensive whole life policy. what can I do?

anon88599
Post 2

no, only if the insurance company has fabricated evidence to establish the claim fell outside the terms of the policy. If the insurer is denying the claim improperly, it is more a breach of contract and is remedied under contract law principles.

anon53786
Post 1

would it be insurance fraud if the insurance company was denying coverage of a client for something that is clearly covered in their policy?

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